Delay in diagnosis of thoracolumbar fractures

Abstract

The time interval between the date of trauma and the diagnosis of vertebral column fractures hinders management and increases liability. We have examined the features and implications of this delay. 585 consecutive thoracolumbar fractures (2005-2016), were considered; 382 (65.30%) were males and 203 (34.70%) females. Mean age was 51 yr. Fall from a height (187; 31.97%), simple fall (147; 25.13%) and road accidents (111; 18.97%) were the most frequent causes of trauma. Physical exertion caused 8.38% (N=49). 142 patients (24.27%) were not diagnosed on the injury day (mean = 3.2 days). Delay was longer in females (mean = 5.5 vs. 2.7 days) and shorter in falls from a height (mean = 2.3) or road accidents (2.8). Mean age of diagnosed on the injury day differed from those diagnosed in the first month (49.2 vs 60.1). Plain X-ray signs were found in 7 misdiagnosed cases (46.6%). Delay was more frequent in low mineralization cases. Diagnostic delay of spine fractures is frequent. Some risk profiles can help to reduce it. Careful emergency X-ray examination is encouraged, as well as early magnetic resonance imaging in risk profiles.

Keywords: Diagnostic delay; Misdiagnosis; Osteoporosis; Vertebral fractures.

Figure 1.

AP (a) and lateral (b) spine X-rays on the date of injury of a patient that had an undiagnosed fracture. It shows loss of definition of superior endplate of the 12th thoracic vertebra (white arrow in a), anterior cortical disruption (black arrow in b), and anterior wedging (black arrowheads in b). Those findings were not identified in the emergency department. MRI (9 days after the accident): Sagittal STIR (c), T1 (d) and T2 (e). Images show a band-like bone marrow edema in the superior endplate of 12th thoracic vertebra (arrows in c and d) and a defined line of fracture (black arrows in e).